Cognitive Impairment and Related Factors Among Middle-Aged and Elderly Patients with Type 2 Diabetes from a Bio-Psycho-Social Perspective

Figures & data

Table 1 Sociodemographic, Disease, Psychological, Self-Management, and Social Support Factors at Baseline Stratified by Cognitive Impairment

Variable	Total (n=240)	Cognitive Impairment (n = 126)	No Cognitive Impairment (n = 114)	P value^a
N (%)	240	126 (52.5)	114 (47.5)	−
MoCA score	24.72±3.64	21.83±2.54	27.92±1.10	<0.001
Sociodemographic factors
Age (years)	61.15±8.15	63.52±8.80	58.54±6.47	<0.001*
~45	127 (52.9)	52 (41.3)	75 (65.8)	<0.001*
~60	113 (47.1)	74 (58.7)	39 (34.2)	−
Sex
Male	155 (64.6)	77 (61.1)	78 (68.4)	0.237
Female	85 (35.4)	49 (38.9)	36 (31.6)	−
Education (years)
≤12	165 (68.8)	106 (84.1)	59 (51.8)	<0.001*
>12	75 (31.3)	20 (15.9)	55 (48.2)	−
Place of residence
Rural	42 (17.5)	37 (29.4)	5 (4.4)	<0.001*
Urban	198 (82.5)	89 (70.6)	109 (95.6)	−
Professional status
On-job	98 (40.8)	41 (32.5)	57 (50.0)	0.006*
Unemployed or retired	142 (59.2)	85 (67.5)	57 (50.0)	−
Smoking
Yes	90 (37.5)	43 (34.1)	47 (41.2)	0.256
No	150 (62.5)	83 (65.9)	67 (58.8)	−
Drinking
Yes	32 (13.3)	18 (14.3)	14 (12.3)	0.648
No	208 (86.7)	108 (85.7)	100 (87.7)	−
Received diabetes education
Yes	104 (43.4)	51 (40.5)	53 (46.5)	0.348
No	136 (56.7)	75 (59.5)	61 (53.5)	−
Disease factors
BMI (kg/m^2)	24.57±2.68	24.52±2.65	24.61±2.73	0.518
<18.5	10 (4.2)	7 (5.6)	3 (2.6)	0.111
~18.5	95 (39.6)	46 (36.5)	49 (43.0)	−
~24	110 (45.8)	64 (50.8)	46 (40.4)	−
~28	25 (10.4)	9 (7.1)	16 (14.0)	−
Diabetes course (years)	10.00 (5.00, 14.00)	10.00 (5.00, 15.00)	8.00 (5.00, 12.00)	0.005*
<10	112 (46.7)	45 (35.7)	67 (58.8)	<0.001*
≥10	128 (53.3)	81 (64.3)	47 (41.2)	−
Hypoglycemia in 1 month
Yes	60 (25.0)	39 (31.0)	21 (18.4)	0.025*
No	180 (75.0)	87 (69.0)	93 (81.6)	−
Diabetes treatment
Lifestyle only	8 (3.3)	2 (1.6)	6 (5.3)	0.050
Oral hypoglycemic drugs	131 (54.6)	63 (50.0)	68 (59.6)	−
Insulin	49 (20.4)	33 (26.2)	16 (14.0)	−
Oral hypoglycemic drugs+insulin	52 (21.7)	28 (22.2)	24 (21.1)	−
Hypertension
Yes	135 (56.3)	82 (65.1)	53 (46.5)	0.008
No	104 (43.4)	43 (34.1)	61 (53.5)	−
Cardiovascular disease
Yes	42 (17.5)	21 (16.7)	21 (18.4)	0.721
No	198 (82.5)	105 (83.3)	93 (81.6)	−
Peripheral vascular disease
Yes	150 (62.5)	76 (60.3)	74 (64.9)	0.463
No	90 (37.5)	50 (39.7)	40 (35.1)	−
Peripheral neuropathy
Yes	108 (45.0)	55 (43.7)	53 (46.5)	0.659
No	132 (55.0)	71 (56.3)	61 (53.5)	−
Diabetic nephropathy
Yes	69 (28.8)	34 (27.0)	35 (30.7)	0.525
No	171 (71.3)	92 (73.0)	79 (69.3)	−
Diabetic retinopathy
Yes	46 (19.2)	25 (19.8)	21 (18.4)	0.780
No	194 (80.8)	101 (80.2)	93 (81.6)	−
HbA1c (%) ^	8.75±1.99	9.09±2.18	8.37±1.69	0.005*
<7	50 (20.8)	22 (17.5)	28 (24.6)	0.176
≥7	190 (79.2)	104 (82.5)	86 (75.4)
FPG (mmol/l)	8.31±2.65	8.44±2.79	8.16±2.49	0.420
TC (mmol/l)	4.68±1.08	4.57±1.10	4.80±1.06	0.103
TG (mmol/l)	1.56 (1.11, 2.20)	1.56 (1.02, 2.14)	1.59 (1.17, 2.62)	0.092
HDL (mmol/l)	1.01±0.24	1.03±0.27	1.00±0.21	0.436
LDL (mmol/l)	3.05±1.00	2.95±1.02	3.15±0.98	0.112
AST (U/l)	19.00 (17.00, 26.00)	18.50 (16.75, 26.00)	19.00 (17.00, 26.00)	0.846
ALT (U/l) ^#	21.00 (16.00, 33.00)	19.50 (15.00, 27.0)	23.00 (17.00, 36.00)	0.002*
≤35	184 (76.7)	101 (80.2)	83 (72.8)	0.179
>35	56 (23.3)	25 (19.8)	31 (27.2)
BUN (mmol/l)	5.93±2.24	6.00±2.71	5.86±1.57	0.649
Cr (μmol/l)	70.00 (60.00, 83.00)	71.50 (61.75, 83.50)	66.00 (59.00, 79.00)	0.079
Psychological factors
SDS score	35.33±10.37	37.94±11.87	32.43±7.45	<0.001*
≥53 points	39 (16.3)	32 (25.4)	7 (6.1)	<0.001*
<53 points	201 (83.8)	94 (74.6)	107 (93.9)
Self-management factors
DSCS score	86.66±17.79	79.80±17.77	94.24±14.48	<0.001*
Exercise score	12.68±4.95	11.34±4.63	14.16±4.90	<0.001*
Diet management score	21.05±6.02	20.10±6.20	22.11±5.65	0.009*
Medication management score	13.90±2.28	13.73±2.55	14.09±1.93	0.219
Blood glucose monitoring score	9.48±3.49	8.21±2.84	10.89±3.61	<0.001*
Foot care score	17.48±5.29	15.52±5.61	19.64±3.92	<0.001*
High and low blood sugar prevention and treatment score	12.32±2.90	11.41±3.04	13.32±2.36	<0.001*
Social factors
SSRS score	41.60±5.30	39.70±4.97	43.70±4.86	<0.001*
Objective support score	10.53±1.90	9.86±1.57	11.28±1.95	<0.001*
Subjective support score	24.59±3.61	23.44±3.66	25.84±3.12	<0.001*
Support utilization score	6.60±1.71	6.38±1.81	6.84±1.57	0.037*

Notes: ^aChi-squared test for categorical variables, Student’s t-test and Mann–Whitney U-test for continuous variables; ^Targets for comprehensive control of type 2 diabetes; ^#Normal laboratory limit; *P < 0.05.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BUN, blood urea nitrogen; Cr, creatinine; DSCS, Diabetes Self-care Scale; FPG, fasting plasma glucose; HbA1c, glycated hemoglobin A1c; HDL, high density lipoprotein; LDL, low density lipoprotein; MoCA, Montreal Cognitive Assessment; SDS, Self-Rating Depression Scale; SSRS, Social Support Rating Scale; TC, total cholesterol; TG, triglyceride.

Table 2 Multivariate Logistic Regression Analysis of Cognitive Impairment in Patients with Type 2 Diabetes

Variable	β	SE	Wals χ ^2	OR	95% CI	P
Age	0.121	0.024	25.272	1.128	1.076–1.182	<0.001
Education >12 years	−1.325	0.392	11.435	0.266	0.123–0.573	0.001
Living in urban area	−2.031	0.603	11.325	0.131	0.040–0.428	0.001
Hypoglycemia in 1 month	1.022	0.412	6.151	2.778	1.239–6.230	0.013
Depression	0.655	0.561	1.363	1.925	0.641–5.782	0.243
DSCS score	−0.059	0.011	28.442	0.942	0.922–0.963	<0.001
Constant	0.072	1.674	0.002	1.075		0.966

Abbreviations: CI, confidence interval; DSCS, Diabetes Self-care Scale; OR, odds ratio; SE, standard error.